The Scottish Government has set out that public health improvement going forward will be underpinned by coordinated action between different organisations, and therefore partnership and collaborative approaches are vital to the future of the health service. But these partnerships are faced with their own set of challenges. Liz Hancock, Head of the School of Health Sciences, answers questions about these challenges and how RGU is tackling them to influence current and future care of people in the community.
Liz, what can you tell us about the situation facing newly qualified health professionals?
Our main objectives, as set out by the overarching UK Government public health policy, are to empower people to live in their own home environment in the community for longer, as we work with other service providers to reduce health inequalities and move towards a more anticipatory and preventive agenda rather than a reactive service. Back in 2012 the National Records of Scotland predicted that by 2035 our population is set to increase by 27% in the 60-74 age-group, and 82% in the 75 plus age group, and so we’re preparing our students to be able to work effectively in that environment in order to deliver the public health objective.
Our students develop the skills and knowledge to recognise and reduce inequalities in the health system, and every contact point in their day-to-day work can provide an opportunity to do this. As with all health and social care professionals they must work within budget constraints, and with an ageing and increasing population we are seeing an ever-increasing impetus to develop students to think and work in a more efficient and effective way, to maximise the impact of public spending.
This sounds like a difficult situation. Where do you start?
NHS Scotland says that the objective can be delivered through person-centred approaches and partnership working. For many years we have embedded person centred care within our teaching as a key focus, so the area of most development and interest is in partnership working. Although from an academic perspective, there is limited published research on the topic of partnership working, we now have a better understanding of the associated challenges and benefits through a number of case studies, and we feed this into our teaching.
How does this work in practice?
Take an example of a pilot study carried out by Elaine Stewart, Lecturer in Occupational Therapy at RGU which related to partnership working between Occupational Therapists and the Fire and Rescue Service. Initiatives have been developed within the UK to advance partnership working between these two service providers in Aberdeen, Dundee, Manchester, Nottingham and Staffordshire. Shared-practice student placements and other opportunities have been developed as part of that programme, and we carried out interviews with Fire Service staff and students in Aberdeen and Dundee to learn more about the partnership’s effectiveness.
Older adults suffer around twice as many fire-related fatalities than the younger population. Evidence shows that the most effective way of providing effective fire safety intervention to those who are hard to reach or who have complex health and social care problems is to deliver collaborative person-centred fire safety interventions in partnership. From an Occupational Therapy perspective this means that risk assessments and fire safety measures are delivered on a person-centred basis, giving service-users choice and dignity.
In our study we found evidence that partnership working reduces duplication, with suggestions of socioeconomic benefits in relation to the public health agenda. Importantly it also suggested a reduction in risk to the service user, and the promotion of awareness of the roles of Occupational Therapists and the Fire and Rescue Service in the community. In other case studies we've seen; increased clarity in the referral pathway, number of referrals, development of joint protocols for information sharing and intervention, and increased awareness of mental health. More evidence to support that partnership working is very valuable to vulnerable people, and the community.
In what other ways is RGU instilling the partnership approach?
In addition to current partnership working, our aim is for us to enable people who will be empowering individuals to self-manage chronic conditions and challenge their current lifestyles tomorrow, so it’s critical that we have a very close partnership with the NHS, local authorities and the voluntary sector. For some courses, members of these organisations sit on our selection panels. We want to instil the health promotion ethos from the outset and so we offer our students placement experiences in partnership settings as early as possible, and continuously through their studies. We provide early placements, which means that our students are being exposed to issues from real service-users as they learn and develop critical thinking skills. There are also opportunities to work with charity groups such as Brain Injury Grampian, MS Society, Sport Aberdeen and Alzheimer’s Scotland so that they experience what it’s like to play a role in community health care. In addition elective placements offer students opportunities to study abroad and we have a number of exchange partnerships designed to expand students’ experience of other health systems and health cultures.
As an extension to partnership working, we facilitate our students’ early experiences of inter-professional learning. We do this through a variety of learning experiences which brings together students from across a range of disciplines to learn with, from and about one another in order that they will work seamlessly as an integrated team in practice. This includes students studying pharmacy, biomedical science, diagnostic radiography, medicine, nursing, nutrition and dietetics, physiotherapy, midwifery, occupational therapy and social work. This promotes collaborative working and critical reflection and analysis of the inter-agency and inter-professional processes that they will be challenged to work in and develop. It is essential for public health promotion that our students hold a positive and strategic approach to public health, and are not afraid to critically assess practices and processes in order to positively impact the population.
How will these changes in the approach to health care impact those who are already mid-career in health and related industries?
We’re aware that there are many people who are working in key areas of public health, health promotion and improvement, local government, education, social care, sports, and voluntary organisations who would benefit greatly from the skills and knowledge we can offer. Our MSc in Public Health and Health Promotion for example, gives students the skills to develop new public health approaches, strategies and policies, recognising social detriments, health psychology, the global health agenda, financial crisis, and climate change. It empowers people to challenge policy, as well as ethical and political debates. We recognise that this course is very valuable to people already in the workforce, and so we’ve made it accessible through part-time online distance learning, which means it’s available to a people in a wide range of careers, all across the world, who have a common interest in health promotion and the development of health services.
Why has RGU decided that now is the right time for this course?
We’ve actually been delivering the MSc in Public Health and Health Promotion since 2009. In recognition of the significance of the ethos of the course, in 2014 we integrated overarching themes into our undergraduate degree courses, including Occupational Therapy, Diagnostic Radiography, Physiotherapy, Nutrition and Dietetics, as well as our Nursing and Social Sciences courses. We believe that the only way we can shift the tide is if everyone is on the same page, and everyone is aware of the issues we are facing as an industry, and are empowered to face them confidently.
Do you see there being many health changes in the future?
The vision for primary care is that by 2030 primary and community care will be at the heart of the healthcare system. Highly skilled multidisciplinary teams will be delivering care in locality clusters with GP’s involved in strategic planning. Action is therefore required to support NHS staff in the areas of extending partnerships across services and sectors, developing preventative strategies to address inequalities and embedding public health and health promotion into practice. There is also a need to address the development of leadership for quality improvement, the ability for health service staff to contribute and be involved in new and innovative ways of working through research and better use of technology, and preparing them to be responsive to the needs of the population – wherever they may be in the world.
What kind of content does the course cover?
Taught modules include The Principles and Concepts of Health Promotion and Public Health, Inequalities, Evidenced–based Public Health, Global Health, Health Psychology and Behaviour Change, Population Health and Wellbeing, Leading Change and Partnerships, and Research Project. These are all completed over a three year period in order to achieve the MSc in Public Health and Health Promotion.
How can students and professionals ensure that they are always informed and progressing with their personal development?
For people who can’t commit to the time or cost of a part-time, three-year course, we do offer a flexible framework route, which has a six-year timeframe to complete to desired award. Students can cherry-pick from a portfolio of interesting and relevant modules to create a tailored programme, specific to their own role within the health service, their career ambitions, or area of interest. Students wishing to do a handful of modules can exit with a Postgraduate Certificate, and with a few more they can build up to a Postgraduate Diploma. Completing a Research Project leads to an MSc, which is all achievable through online distance learning with the support and expertise of dedicated staff within RGU.
We know that through the delivery of our courses we can make a difference to tomorrow’s health service, and that’s why it’s so important to us to make them accessible not only to students joining us straight from School, but also those who are currently embedded within a health care setting. Both the three-year course and the flexible programme have a New Year intake, so there’s still time to join in January for anyone wishing to develop their role in the future.